West Virginia Hopes DM Program Will Control Medicaid Drug Costs

September 1, 1998

West Virginia Gov. Cecil H. Underwood last month unveiled a disease management program to control Medicaid prescription drug costs. The governor chose the new program instead of a formulary, which a study group he appointed had proposed.

The National Pharmaceutical Council, a not-for-profit organization funded by a group of drug manufacturers, will provide $500,000 for the startup. West Virginia is seeking to cut Medicaid drug costs by $14 million a year, about 10 percent of the $147 million the state spent on drugs for Medicaid beneficiaries in 1997.

The new program will try to educate Medicaid beneficiaries so they'll take their medicines more faithfully and comply more fully with their treatment plans. The hope is that the eventual result will be fewer emergency room visits and lower overall health care costs. The state concedes that prescription drug costs will probably increase in the first year of the disease management program.

Virginia's Health Outcomes Partnership, the only similar state program in the nation, didn't realize substantial savings for four years, says Elizabeth S. Lawton, West Virginia's commissioner of medical services.

The new program will be modeled in part on that of Virginia, where registered pharmacists attend seminars on communication skills and management of different disease states to enable them to improve their counseling skills.

West Virginia anticipates that its disease management program will have "an impact" after its first year. At first, the program will focus on one or two diseases, which have not yet been identified.

The West Virginia Pharmacists Association strongly supported the formulary option.